Sunday, October 1, 2017

In the NEWS: Point of Care ultrasound of the Lungs and the Nephrologists


Typical B-line (left) and the standard definition by Lichtenstein (right).Point of care US is increasingly being used in many medical specialties. Nephrology is catching along swiftly as well.  A recent review by our team led by Ross et al discuss the role of Lung US in the ESRD population.  After a systematic review,  we concluded that lung US can be used to determine volume status in chronic ESRD patients by using the B-line score model( see figure above from paper) as discussed in the paper.


As nephrologists, we should be using this in practice and help diagnose and prognosticate high risk patients and perhaps prevent re-admissions.

The role of lung ultrasonography in nephrology practice requires further research regarding its clinical applications. We stated in our paper the following amazing ways it can be used in clinical practice..
i.            What is the role of lung ultrasonography in the management of AKI in the intensive care unit? Could it be used as an endpoint for continuous renal replacement therapy?
ii.            Given the association of mortality with the presence of B-lines in the chronic dialysis population, what is the role of lung ultrasonography in the management of the patient on chronic HD? Could B-lines be used to guide need for increased ultrafiltration and would this change long-term outcome?
iii.            Could lung ultrasonography be used to guide diuretic therapy in patients with chronic cardiorenal syndrome?
iv.            As B-lines detect subclinical volume expansion, could lung ultrasonography be useful in differentiating hypervolemic from euvolemic hyponatremia?

Where can one learn to get point of care US training?
The Emory US course is the mecca of US training: check out the details here
NKF Spring Clinical Meetings 2017 had a course run by us as a pre-course specifically on point of care US. Similar course will be prepared for 2018
KidneyCon 2018 will also be having a hands on workshop for Point of care US training

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